State Board of Education hears sobering details of the pandemic’s impact on youth mental health

Trauma, depression, and suicide have spiked and a bill in the General Assembly could make things worse

The pandemic has been unkind to America’s school children.

Academically, K-12 students experienced significant learning loss while stuck at home during the height of the pandemic.

Meanwhile, mental healthcare experts are concerned about the social and emotional well-being of children, many of whom struggled with anxiety and depression while being separated from classmates and lacking the support of school counselors, teachers and other staff.

According to Centers for Disease Control and Prevention data shared at a recent State Board of Education meeting, 37% of youth have experienced poor mental health during the pandemic and 44% reported persistent feelings of sadness or hopelessness during the past 12 months.

The pandemic helped to expose a disturbing trend that health experts say has been worsening for at least a decade. “Those are issues that were present and increasing before the pandemic and certainly the pandemic accelerated how quickly we’re seeing rises in the number of children and families struggling with these issues,” said Dr. Charlene Wong, assistant secretary for children and families at the NC Department of Health and Human Services.

From 2009-to 2019, the proportion of high school students reporting persistent feelings of sadness or hopelessness increased by 40%, Wong said, citing CDC data. There was a 36% increase in students “seriously” considering or attempting suicide during that span. And between 2011-2015, the nation saw a 28% increase in youth going to emergency departments for depression, anxiety and behavioral challenges.

These North Carolina-specific trends Wong shared show the indelible mark the pandemic has left on this state’s schoolchildren:

• 3,600 or more North Carolina children have been traumatized by the loss of a parent/caregiver to COVID-19.
• There has been a 46% increase in youth with one or more major depressive episodes during the pandemic (2020-21).
• The rate of children discharged from emergency departments with a behavioral health condition increased by an estimated 70% in the pandemic.

Students with close connections to people at school fared better than those do who did not have such relationships, Wong said. Fifty-three percent of students who did not feel close to someone at school reported persistent feelings of sadness or hopelessness over the last 12 months, compared with 35% who did.

Twenty-six percent of those who reported no close connections at school considered suicide compared with 14% of those who did feel close to someone. A similar gap existed for students who attempted suicide. Twelve percent of students who said they did not feel close to someone at school attempted suicide compared with 6% of those who said they felt connected to someone.

“What we know is that feeling close to someone at school really provides important protections for students,” said Wong, a practicing primary care pediatrician.

Proposed legislation could compound the problem

Female students and LGBTQ+ youth experienced worse mental health threats during the pandemic than other demographics, Wong said.

State experts say a House bill working its way through the General Assembly could only make conditions worse for LGBTQ youth.

Republican-backed House Bill 755, also known as the “Parents’ Bill of Rights” would prohibit instruction on sexual orientation or gender identity in grades K-3. But as reported by Policy Watch this week, HB 755 would also require schools to notify parents if any student under 18 asks to be addressed by a gender pronoun different from the gender assigned at birth. It would also prohibit teachers or administrators from withholding “information about his or her mental, emotional, or physical health,” which would include LGBTQ students expressing frustration that they can’t come out to families who would not support them.

Shana Gordon, a licensed professional counselor and therapist with Tree of Life Counseling, which has North Carolina offices in Greensboro and Jacksonville, told Policy Watch that that could be dangerous for LGBTQ youth.

“Maybe they know they’ll face abuse at home if they come out, that their parents will throw them out, that they’ll send them to a camp to try to ‘cure’ them. But also, sometimes coming out is a process, even with themselves. A lot of people do it in steps and that’s okay.”

Gov. Roy Cooper is expected to veto the bill if it gets to his desk.

Pilot program targets student mental health problems

Ashley Padgett, director of family and community engagement for Beaufort County Schools, has seen the damage the pandemic has caused in the lives of students and families in the small county of about 45,000 in the eastern part of the state. Food insecurity, for example, brought on by pandemic-related income losses for families has contributed to anxiety, depression and behavioral problems in students, Padgett said.

School leaders often learn about students’ struggles at home after they act out in school, she said.

“School leaders are really good at not just responding to the inappropriate behavior, but during those conversations, they’re also really good at finding out what that kid needs beyond that,” Padgett said. “We get a lot of our mental health referrals from that misbehavior.” 

The Beaufort County School district is one of six participating in state pilot program called Project Aware/Activate that’s working to develop a plan of activities, services and strategies to connect youth and families to mental health services.

The program is a collaboration between NCDHHS and the NC Department of Public Instruction. Funding is provided by the Substance Abuse and Mental Health Services Administration, a federal agency that leads efforts to improve the behavioral health of the nation and the lives of individuals living with mental and substance abuse disorders.

Local school districts that in the pilot program have flexibility in how they may use the money, Wong said. It may be used for policy development, workforce development or to promote substance abuse prevention.

Preventing school violence

“Part of the Project Aware funding has been used to say, we really want to have more clinicians that we want to hire with this funding, so when we identify young people who are experiencing behavioral health challenges in school, we can quickly connect them with a clinician to that intervention and treatment that they need,” Wong said.

Youth behavioral health has been widely discussed in the days following the tragic school shooting in Uvalde, Texas, where 18-year-old Salvador Rolando Ramos killed 19 students and two adults during a shooting rampage at Robb Elementary School.

Texas mental health officials say Ramos might have been identified early as a potential threat to himself and others had more resources been available. In 2019, the state created the Texas Child Mental Health Care Consortium to identify troubled students and refer them to mental health services. Ramos’ school was on the list to join the program but funding had not yet become available, according to a recent story in The Texas Tribune.

In North Carolina, health officials recently released a coordinated plan designed to help children and families experiencing substance abuse or mental health crises. The plan would cost a recurring annual investment of $23.4 million.

The plan outlines 13 strategies, Wong says, would be a starting point for addressing the state’s child behavioral crisis. The strategies fall into broad categories: Expanding treatment services that prevent children from being removed from their homes or experiencing multiple placements and connecting children to expanded place care options more quickly.

“Many of these strategies are really focused on children who are in the care of our child welfare system who have complex or intensive behavioral health needs,” Wong said. “Many of those strategies would be available for those children as well as a broader population.”